Coverage provided and underwritten by Ameritas Life Insurance Corp
Eligible Duke employees scheduled to work at least 20 hours per week can choose from three dental options, depending on the extent of coverage you and your family may need.
All options cover Type 1 (preventive), Type 2 (basic), Type 3 (major) and Type 4 (orthodontia), but differ in how they pay for covered services.
Preferred Provider Option (PPO) Plan
The PPO plan includes a higher maximum annual benefit than Plan A and Plan B, lower negotiated procedure rates, and your out-ofpocket costs are usually lower. However, participants in the PPO plan will need to select an in-network provider. If you select the PPO plan and use an out-of-network provider, the amount the plan pays will be based on discounted network charges and you will be responsible for any amount charged over that allowance. A list of network dentists is available at the Ameritas website or by calling Ameritas at 1-800-755-8844.
Plan A and Plan B
If you enroll in Plan A, you can select any licensed dentist of your choice. You may also choose to use a network provider. Using a network provider will limit your out-of-pocket cost. Also, if you utilize a network provider, the deductible is waived. Plan B provides a very basic benefit and payments are based on a fixed schedule of fees. The schedule for Plan B is available on the Ameritas website. You should review the fixed schedule before selecting this option.
- Dental Plans Comparison Chart
- 2021 Dental Premiums
- How to Increase Your Annual Maximum Benefit
- Questions to Ask: Making Your Dental Plan Decisions
- Late Entrant Restrictions on Benefits for 2021
All three plans have an annual maximum benefit. If you reach this annual maximum benefit, Ameritas will not reimburse any additional services for the remainder of the calendar year.
Dental plan members who have at least one covered dental claim filed in calendar year 2020, with less than $500 in claims payments, will have their annual maximum benefit increased by $250 in 2021. This accumulation can continue each year until the annual maximum has increased in the PPO plan from $1,250 to $2,250; on Plan A from $1,000 to $2,000; and on Plan B from $750 to $1,750.
When comparing Duke's dental plans, it is important to compare out-of-pocket expenses as well as premiums. Here are some questions to ask yourself when choosing a dental plan that matches the needs of you and your family. For specific coverage information, please refer to the Dental Plans Comparison Chart.
|PPO Plans||Plan A||Plan B|
|Can I visit any dentist?||No, you must use a network dentist||Yes, you may choose any licensed dentist or use a network dentist||Yes, you may choose any licensed dentist or use a network dentist|
|If I don't enroll within 30 days after my date of hire or eligibility and enroll in the future, will I be a "late entrant"?||Yes, please see below for more details||Yes, please see below for more details||Yes, please see below for more details|
|Will my dependent children who live in a different location be covered?||Yes, they may choose a dentist within a nationwide network||Yes||Yes|
|Is there a dental deductible before the insurance will pay for covered services?||Yes, an annual $50 deductible for "major" services||Yes, a $100 lifetime deductible for "basic" services and an annual $75 deductible for "major" services||Yes, a combined annual $50 deductible for "basic" and "major" services|
|Will I have out-of-pocket costs for preventive services?||No||Yes, cost sharing may be required if dentist charges above U&C||Yes|
|I need an existing filling replaced. Will it be covered if I enroll in a Duke dental plan?||Yes, if the filling is at least 6 months old||Yes, if the filling is at least 6 months old||Yes, if the filling is at least 6 months old|
|Are teeth whitening services covered under dental coverage?||No||No||No|
If you and/or your dependent(s) are not currently enrolled for dental coverage through Duke and enroll for 2021, you and/or your dependent(s) will be considered a “late entrant”. As a late entrant, your benefits during 2021 will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other dental or orthodontia procedures or services will be covered during the first 12 months if a member is enrolled as a late entrant.
Once you have been enrolled in a Duke dental plan for at least 12 months, the plan will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance, which applies towards cleaning frequency).
Periodontal procedures, including maintenance/ cleanings, would not be covered during this 12-month period. This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke dental plan,
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption, or
- if you add a child during an open enrollment period prior to his/her second birthday.